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Objective: To compare frequency of surgical site infection between laparoscopic Graham’s omentopexy and open Graham’s omentopexy after duodenal ulcer perforation. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: 31st October 2020 to 30th April 2021. Methods: A total of 86 patients with perforated duodenal ulcer, 25 to 60 years of age, were included. Laparoscopic Graham’s omentopexy was done in Group A patients while open Graham’s omentopexy repair was done in Group B patients. A dose of broad-spectrum antibiotic was given prior to anesthesia. After surgery, all patients were followed up for two weeks to assess the surgical site infection. Results: From 86 patients, 59 (68.60%) were males and 27 (31.40%) were females. Our study has shown the surgical site infection in group A (laparoscopic Graham’s omentopexy) as 01 (2.33%) and in group B (open Graham’s omentopexy) as 11 (25.58%) respectively, with a p-value of 0.002. Conclusion: Our findings show that the surgical site infection is less after laparoscopic Graham’s omentopexy as compared to open Graham’s omentopexy for duodenal ulcer perforation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to investigate the differences in clinical characteristics and surgical outcomes between para-colostomy hernia (PCH) and para-ileal-conduit hernia (PICH) after laparoscopic repairs. Methods: We retrospectively analyzed data from 41 laparoscopic parastomal hernia repairs performed at the Jikei University Daisan Hospital between June 2012 and September 2023. The data were divided into PCH (n=31) and PICH (n=10) groups and compared. Results: The comparison of patient backgrounds and hernia characteristics showed no significant differences between PCH and PICH groups. Surgical procedures included laparoscopic Sugarbaker repair (LSB) for PCH (29 cases) and PICH (8 cases), and endoscopic Pauli repair (ePauli) for both PCH (2 cases) and PICH (2 cases). Intraoperative findings indicated a significantly higher rate of severe intra-abdominal adhesions (Zühlke index III/IV) in the PICH group (60%) compared to the PCH group (23%) (p=0.0485). The median operation time was significantly longer for PICH (223 [120-423] minutes) than for PCH (158 [48-386] minutes) (p=0.0467). Perioperative complications occurred in 1 PCH case (3%) and 2 PICH cases (20%), with no significant difference in postoperative hospital stay (9 [4-19] vs. 9 [6-14] days). With the follow-up period of 57 [2-110] months for PCH and 52 [20-104] months for PICH, recurrence was observed in 4 PCH cases (12%) but not statistically significant. Conclusions: The comparison of PCH and PICH suggests that PICH is associated with more severe intra-abdominal adhesions and longer operation times, indicating higher operative difficulty. Therefore, it would be advisable to discuss the surgical outcomes of repair for these stomas separately.

Introduction: The aim of this study was to evaluate and compare the early postoperative outcomes of patients who underwent laparoscopic and open repair for perforated peptic ulcer disease in our clinic. Materials and Methods: An observational single-center study was conducted at the Marmara University Pendik Training and Research Hospital between June 2018 and June 2023. Demographic characteristics, comorbidities, preoperative laboratory tests, surgical technique, duration of operation, ulcer location (duodenal, gastric, prepyloric), postoperative length of hospital stay, readmission, and complications were analyzed. Patients were divided into two groups, open and laparoscopic operations, and compared. Results: We compared 99 patients who underwent open surgery (OS) with 23 who underwent laparoscopic surgery (LS). The median age of the entire cohort was 42.5 years (IQR 30.3–62). There was no difference between the two groups in terms of ulcer location. The operative time was longer in the laparoscopic group (45 min OS vs. 60 min LS, p<0.001). Although the median length of hospital stay was three days between the two groups, there was a significant difference in favor of the laparoscopic group. There were no significant differences in postoperative complications or 30-day mortality between the two groups (0.754 and 0.684, respectively). Conclusion: Compared with the open method, the laparoscopic method can be safely applied in the surgical treatment of peptic ulcer perforation without increasing complications. In suitable patients, advantages such as shorter hospital stays can be utilized. [ABSTRACT FROM AUTHOR]

A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved. [ABSTRACT FROM AUTHOR]

Key clinical Message Right sided posterior diaphragmatic hernias are a rare diagnosis, especially in adult populations. This patient presented with right thoracic pain for 20 years before investigation. Imaging has provided an accurate diagnosis in this case. Repair can be done safely laparoscopically.

Key clinical Message: Right sided posterior diaphragmatic hernias are a rare diagnosis, especially in adult populations. This patient presented with right thoracic pain for 20 years before investigation. Imaging has provided an accurate diagnosis in this case. Repair can be done safely laparoscopically. [ABSTRACT FROM AUTHOR]

Background: Ventral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed. Objectives: The aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias. Methods: A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Results: Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32–0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19–0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02–0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19–0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Conclusion: The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma. [ABSTRACT FROM AUTHOR]

Obesity is the fifth leading cause of death worldwide. In turn, ventral hernias (including an inguinal hernias) are one of the most common cases in general surgery. Minimally invasive techniques (laparoscopic or robot-assisted procedures) are becoming more and more popular in ventral hernia treatment compared to open procedures. The aim of this study is to analyze the impact of body mass index (BMI) value on the efficacy and safety of laparoscopic ventral hernia repairs, including inguinal hernia repairs. Numerous studies evaluating this relationship are available. In most studies, There were also no statistically significant differences in the rate of intraoperative complications, the median operative time, the median length of hospital stay, the rate of postoperative pain, the surgical site infection, the rate of postoperative complications, the median time to recurrence, and the rate of early and late recurrences between groups with different BMI values. Moreover, studies proved that laparoscopic ventral hernia repair in obese patients is more effective compared to the open repair. The analysis revealed that high BMI values do not have a statistically significant impact on the outcomes of laparoscopic repair, including robot-assisted laparoscopic repair, in patients with ventral hernias. However, it should be noted that the analyzed studies often have limitations. For this reason, it is essential to conduct multicenter studies and perform long-term evaluations of patients.

We report a case of a Morgagni hernia repaired by primary closure with an extra-abdominal suture. Moreover, we reviewed cases of laparoscopically repaired Morgagni hernia, in which the size of the hernia defect was known, to establish a size criterion for mesh utilization. An 87-year-old woman presented to our hospital with right upper abdominal pain and vomiting. She had no history of abdominal surgery or trauma. Chest radiography and computed tomography (CT) revealed a Morgagni hernia, with the stomach and transverse colon herniated into the right chest cavity. Initially, an endoscopic repair was performed for the herniated stomach due to her age, which was successful. However, she had a recurrence 2 days later, prompting us to perform a semi-emergent laparoscopic surgery. Laparoscopic examination revealed a Morgagni defect, with the omentum, transverse colon, and stomach herniated, with the stomach reduced by pneumoperitoneum. Fortunately, the herniated organs could be easily relocated into the abdomen with no adhesions. The hernia defect measured 6 x 3 cm. We performed primary closure with an extraabdominal suture. No sac resection was performed. The operation lasted 98 min. Oral intake was initiated on postoperative day 1, and the patient was discharged on postoperative day 3 without complications. Chest radiography and CT scans at 1 month postoperatively showed no recurrence, and the patient remained asymptomatic at the 9-month follow-up examination. According to our review findings, primary closure is an efficient method for small hernia defects (rule of thumb: width, <4 cm; length, <7 cm). [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia, a common surgical problem, requires treatment to prevent complications and improve patient outcomes. The debate continues as to whether laparoscopic or open repair techniques are superior. This study assesses the success rates of laparoscopic and open inguinal hernia repairs in Vidarbha, Maharashtra. Methods: The 100 Vidarbha, Maharashtra people who needed laparoscopic or open inguinal hernia repair were the subject of a retrospective study. Demographic information, recurrence rates, complications, postoperative pain scores, and duration of hospital stay were related between the two groups. Statistical study was used to determine the significance of the observed differences. Results: The laparoscopic (10%) and open (15%) repair groups had comparable recurrence rates. By comparing the two methods for hernia prevention yielded comparable less pain than open method results. The rate of complications in the laparoscopic group was 8%, while in the open repair group, it was 12% Laparoscopic procedures were associated with shorter hospital stays than open procedures. Statistical analysis demonstrated the importance of these results. Conclusion: This study demonstrates that both laparoscopic and open hernia repairs are equally effective at reducing the risk of recurrence and causing roughly the same level of postoperative discomfort. Laparoscopic surgery has the advantage of reducing the duration of hospital stays. Resources, surgeon experience, and patient characteristics should be considered when deciding between laparoscopic and open repair. It is suggested that additional research be conducted to substantiate and assess the long-term effects of these findings. [ABSTRACT FROM AUTHOR]

A groin hernia is a common presenting complaint for adults and surgical repair is usually recommended if symptomatic. Patients may present with swelling or pain in the groin and one should be cognizant of the surgical emergency of a strangulating or obstructing hernia. A careful history and examination will help determine differential diagnoses as well as planning the potential approach for repair. Surgical techniques have developed in recent years with a move towards favouring laparoscopy in the elective patient. For both open and laparoscopic approaches, there are recognized techniques to consider. It is crucial to have a clear understanding of the anatomy in order to develop the skills required for accurate dissection, reduction and repair. Complications, although rare, can lead to severe morbidity. Laparoscopy has the advantage of reducing postoperative chronic pain but requires greater skill and experience to perform successfully. This chapter outlines the key considerations and surgical techniques for groin hernia repair and should be used in conjunction with practical training. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic inguinal hernia surgery (LIHS) is the recommended procedure for bilateral and recurrent inguinal hernias (IH) while it is one of the options dealing with unilateral inguinal hernias. Aims and objectives: To evaluate the outcome of fixation versus non-fixation of mesh in Totally Extra Peritoneal (TEP). Materials and Methods: All patients admitted in General surgical Ward/unit either through OPD or emergency, presenting with uncomplicated unilateral inguinal hernias were included. A total of 120 patients were included in the study, 60 patients underwent TEP repair without fixation of mesh and in remaining 60 patients mesh was fixed using metallic tacks. Results: The mean age of the patient was 45.05 ± 16.50 years and 44.98 ± 15.85 years in the fixation and non-fixation group, respectively. 41.66% of the cases among the fixation and 35% in non-fixation of mesh in laparoscopic TEP repair of inguinal hernia were above 50 years of age respectively. Conclusion: We observed that postoperative chronic pain is less likely to develop in patients who undergo Totally Extra Peritoneal (TEP) repair without mesh fixation; moreover, even when chronic pain does develop in such patients, their pain will be mild and unlikely to necessitate re-exploration. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic incisional hernia repair is increasingly performed worldwide and expected to be superior to conventional open repair regarding hospital stay and quality of life (QoL). The INCisional Hernia-Trial was designed to test this hypothesis. Methods: A multicenter parallel randomized controlled open-label trial with a superiority design was conducted in six hospitals in the Netherlands. Patients with primary or recurrent incisional hernias were randomized by computer-guided block-randomization to undergo either conventional open or laparoscopic repair. Primary endpoint was postoperative length of hospital stay in days. Secondary endpoints included QoL, complications, and recurrences. Patients were followed up for at least 5 years. Results: Hundred-and-two patients were recruited and randomized. In total, 88 patients underwent surgery and were included in the intention-to-treat analysis (44 in the open group, 44 in the laparoscopic group). Mean age was 59.5 years, gender division was equal, and BMI was 28.8 kg/m. The trial was concluded early for futility after an unplanned interim analysis, which showed that the hypothesis needed to be rejected. There was no difference in primary outcome: length of hospital stay was 3 (range 1–36) days in the open group and 3 (range 1–12) days in the laparoscopic group (p = 0.481). There were no significant between-group differences in QoL questionnaires on the short and long term. Satisfaction was impaired in the open group. Overall recurrence rate was 19%, of which 16% in the open and 23% in the laparoscopic group (p = 0.25) at a mean follow-up of 6.6 years. Conclusions: In a randomized controlled trial, short- and long-term outcomes after laparoscopic incisional hernia repair were not superior to open surgery. The persisting high recurrence rates, reduced QoL, and suboptimal satisfaction warrant the need for patient's expectation management in the preoperative process and individualized surgical management. Trial registration: Netherlands Trial Register NTR2808. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic transabdominal preperitoneal repair (TAPP) was recommended for female patients with groin hernias. Whereas, only a few studies focused on whether and how to preserve the round ligament of the uterus in TAPP. Methods: Clinical data of 159 female patients with 181 groin hernias who underwent TAPP at a single institution in China from January 2016 to June 2022 were retrospectively reviewed and collected. Results: All the patients underwent the operation smoothly without conversion. Division of the round ligament was performed for 33 hernias. Preservation of the round ligament was adopted for 148 hernias, 51 with the "keyhole" technique, 86 with the "longitudinal incision of peritoneum" method, and 11 with total dissection of the round ligament. The mean operative time was 55.6 ± 8.7 min for unilateral TAPP and 99.1 ± 15.8 min for bilateral TAPP. The mean estimated blood loss was 7.1 ± 4.5 mL. The postoperative complications included 6 (3.3%) cases of seroma, 1 (0.5%) case of hematoma, and 3 (1.6%) cases of mild chronic pain. The incidences of chronic pelvic pain and genital prolapse seemed to be higher in the division group than in the preservation groups (6.1% vs. 0.6% and 3.0% vs. 0%, separately). However, no statistical difference was observed (p > 0.05). Conclusions: TAPP is feasible and effective for female patients with groin hernias, especially in preserving the round ligament of the uterus. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic transabdominal preperitoneal repair (TAPP) was recommended for female patients with groin hernias. Whereas, only a few studies focused on whether and how to preserve the round ligament of the uterus in TAPP. Methods Clinical data of 159 female patients with 181 groin hernias who underwent TAPP at a single institution in China from January 2016 to June 2022 were retrospectively reviewed and collected. Results All the patients underwent the operation smoothly without conversion. Division of the round ligament was performed for 33 hernias. Preservation of the round ligament was adopted for 148 hernias, 51 with the “keyhole” technique, 86 with the “longitudinal incision of peritoneum” method, and 11 with total dissection of the round ligament. The mean operative time was 55.6 ± 8.7 min for unilateral TAPP and 99.1 ± 15.8 min for bilateral TAPP. The mean estimated blood loss was 7.1 ± 4.5 mL. The postoperative complications included 6 (3.3%) cases of seroma, 1 (0.5%) case of hematoma, and 3 (1.6%) cases of mild chronic pain. The incidences of chronic pelvic pain and genital prolapse seemed to be higher in the division group than in the preservation groups (6.1% vs. 0.6% and 3.0% vs. 0%, separately). However, no statistical difference was observed (p > 0.05). Conclusions TAPP is feasible and effective for female patients with groin hernias, especially in preserving the round ligament of the uterus.

Background: Perforated peptic ulcer (PPU) is a common surgical emergency. Exploratory laparotomy and repair with the omental patch are routine surgical intervention till now. In developing counties, laparoscopic repair is still not considered the gold standard in this emergency condition. Objectives: This study was conducted to evaluate laparoscopic management of PPU in terms of peri-operative outcomes. Patients and methods: This prospective observational study included 151 patients who presented with PPU in three tertiary hospitals from February 2018 to February 2023. Patients were divided into two groups: group (L) included 75 patients who received laparoscopic management, and group (O) included 76 patients who received open management. Demographic and peri-operative data were collected tabulated and analysed. Results: No statistically significant difference between the studied groups regarding demographic and clinical data. The laparoscopic management group had statistically significant longer operative time (95±10.6 vs. 60±14.6 min.), lower doses of narcotic injections (1.564±0.432 vs. 5 ± 0.175), lower mean pain Visual Analogue Scale (VAS) (3±1 vs. 7±1), shorter time to resume oral feeding (2.1 ±.52 vs.3.4 ±.576 days), lower incidence of postoperative ileus, lower incidence of chest infection and wound infection, shorter hospital stay (5±1.54 vs. 8±1.6 days), shorter time to return to daily normal activities (12±2.9 vs. 24±3.4 days), and better satisfaction about cosmetic results. No statistically significant difference between the studied groups regarding postoperative leakage of the repair and incidence of intra-abdominal septic complications. Conclusion: Laparoscopic management of PPU has statistically significant better postoperative outcomes. It could be adopted as a standard technique in cases with small perforation, Boey’s score ≤ 1, and Mannheim Peritonitis Index ≤ 20.

Abstract Background Acute diaphragmatic hernia is a life-threatening condition caused by prolapse of an abdominal organ into the thoracic cavity through a defect in the diaphragm. We present herein a case of acquired diaphragmatic hernia following a peritoneal biopsy for gastric cancer dissemination in the diaphragm. Case presentation A 72-year-old, female patient presented with a complaint of acute abdomen 10 months after receiving a diagnosis of stage IV gastric cancer with peritoneal dissemination based on peritoneal biopsy findings during staging laparoscopy. Computed tomography demonstrated herniation of the small intestine into the thoracic cavity. Emergency surgery was performed, and a full-thickness diaphragmatic defect was found intraoperatively at the same location as the previous, peritoneal biopsy. The incarcerated small intestine was atraumatically repositioned into the abdominal cavity, and the defect was closed laparoscopically using an absorbable barbed suture. Conclusions Although complications of staging laparoscopy are extremely rare, excising disseminated nodules from the diaphragm carries the risk of diaphragmatic hernia. For this reason, avoiding excision is desirable unless a diaphragmatic biopsy is needed.

Purpose: The advantage of using the single-port technique over the conventional two-port approach is uncertain. This study aimed to evaluate the outcomes of a single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) using a modified needle grasper in children and compare the results to those of two-port laparoscopic percutaneous extraperitoneal closure (TLPEC). Methods: A retrospective cohort analysis of SLPEC and TLPEC surgery from February 2016 to June 2021 was conducted at our institution. Pediatric patients underwent SLPEC using the modified needle grasper to complete the high ligation of the hernia sac, while operations in the conventional two-port group only used regular laparoscopic instruments. A 1:1 propensity score matching (PSM) analysis was used to reduce selection bias. Results: Of 1320 patients, 1169 were included in the single-port/two-port crude evaluation, with 930 in the PSM cohort (465 patients/arm). Among 1:1 matched patients, the operation time for single-port patients vs. two-port patients were 11.28 ± 3.98 vs. 15.47 ± 4.54 min for unilateral repair and 16.86 ± 4.59 vs. 20.40 ± 4.29 min for bilateral repair (p <.05). Cosmetic results did not differ between the SLPEC and TLPEC groups (0% vs. 0.7%, p = 0.249). The recurrence rates were comparable between the two groups (0.6% vs. 1.1%, p = 0.725). Moreover, the differences in surgical site infection (SSI), testicular atrophy, open conversion and postoperative hydrocele occurrence were insignificant between the two groups. Conclusions: In this cohort study, the modified needle grasper is a safe and feasible instrument for SLPEC, and SLPEC using the needle grasper has a shorter operation time than TLPEC. [ABSTRACT FROM AUTHOR]

Purpose: Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. Methods: All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. Results: Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3 cm vs. 5.0 cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95 min) and shorter postoperative hospital stay (median 8 vs. 11 days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. Conclusion: The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself. [ABSTRACT FROM AUTHOR]

Introduction: Mesh fixation in inguinal hernia repair, has been a controversial subject for many years. Therefore, in this study, we evaluated and compared fixation and non-fixation of mesh in Transabdominal Preperitoneal (TAPP) Inguinal hernia repair. Methods: In this randomized control trial, 100 patients diagnosed with unilateral inguinal hernia were included. We divided the study population into two groups of fifty. For both groups, a 15 × 13 cm Prolene(polypropylene) mesh was used for repair. In the fixation group, mesh was fixed to the abdominal wall by endoscopic tacks, while in the non-fixation group, mesh was secured at the proper place without any fixation. Postoperative outcomes were complications, recurrence, and pain intensity after 1-, 3- and 6-months. Results: Postoperative pain intensity in the 1st month [Median of 2 and 0, (P < 0.001)], and 3rd month [Median of 0.5 and 0, (P < 0.001)], in the fixation group were significantly higher than the non-fixation group. However, 6 months after surgery, pain intensity was almost similar for both groups. In the 6th postoperative month, only one patient experienced recurrence who was in the fixation group. The rate of recurrence and urinary retention between the groups was not significant. Conclusion: It was observed that until 6 months after surgery patients who received the non-fixating method of TAPP repair experienced lower levels of pain in comparison to the fixation group while other complications did not differ between the two groups. This trail was registered at www.irct.ir with Trial Registration Number of IRCT20210224050491N1. [ABSTRACT FROM AUTHOR]

Background: Slipping rib syndrome (SRS) is an often unrecognized cause of lower chest and upper abdominal pain in children and adolescents. Surgical resection of the cartilaginous portions of the slipping rib often provides permanent pain relief, with the standard surgical approach being an open resection. A minimally invasive approach has not been reported previously; we report a novel laparoscopic technique for the treatment of SRS with satisfactory results. Materials and Methods: A retrospective review of all consecutive pediatric patients who underwent laparoscopic cartilage resection during the year 2019 and open cartilage resection during the year 2018 was included. Following data were recorded: age of patients, length of symptoms, length of procedure, length of cartilage resection, length of stay, resolution of pain, cosmetic acceptability, and postoperative complications. Results: Four patients underwent laparoscopic slipping rib resection without complication during the year 2019. The mean age of symptom onset was 15 (range 14-16) years old, mean length of symptoms was 1.4 (0.5-2.0) years, and mean age at operation was 16.5 (16-18) years old. The average length of the procedure was 72.8 (55-102) minutes, and mean length of cartilage removed was 2.3 (1.9-3.0) cm. Three patients underwent standard open operation during the year 2018. All patients reported complete resolution of their chronic pain at their 6-month follow-up visit. Conclusions: Laparoscopic technique can be used to treat SRS. All patients reported high satisfaction from resolution of chronic pain and the cosmetic appearance of their surgical scars.

Objective: To compare laparoscopic needle-assisted extra-corporeal hernia repair regarding recurrence in children with intracorporeal repair. Study Design: Retrospective longitudinal study. Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Dec 2020. Methodology: Retrospectively, all patients who underwent laparoscopic herniotomy were searched through hospital records.Ninety-seven patients matched the inclusion criteria out of 148 laparoscopic surgeries. All patients were diagnosed with inguinal hernia based on history and clinical examination. Fifty-one patients underwent laparoscopic needle-assisted repair (LNAR) with extra-corporeal knotting, whereas 46 underwent repair with intracorporeal knotting of the deep inguinal ring. Pneumoperitoneum was created in all cases by open method. All patients were followed up for six months outdoors for recurrence. Results: The age of patients ranged from 1-12 years; the mean age of study patients was 5.29±3.17 years. Regarding the inguinal hernia site, 45(46.4%) had a right-sided hernia, and 52(53.6%) had a left-sided hernia. All operations were completed laparoscopically. There were no intraoperative complications. A total of 2(3.53%) patients developed recurrence, one from each group, 2.17% in Group-A and 1.96% in Group-B, with no statistically significant difference between the two groups after six months of follow-up (p-value=0.942). Conclusion: Extra-corporeal knotting in children with inguinal hernia is an effective, quick and safe technique. It is comparable to the standard intracorporeal knotting technique in terms of recurrence.

Introduction: Recurrent herniation is a well-recognised complication following the repair of a congenital diaphragmatic hernia (CDH). There is no consensus on the optimal surgical approach to manage recurrent CDH. We present a case of laparoscopic correction of recurrent herniation using a non-absorbable patch. Case Presentation: A 13-month old girl presented to the outpatients department with constipation and breath-holding attacks, previously having undergone left CDH surgery on the 7th day of life. The original operation was performed via a subcostal incision and a primary repair was carried out with interrupted non-absorbable sutures. Chest X-ray demonstrated elevation of the left hemi diaphragm with a posterior ‘bulge’ suggesting a recurrence. An elective diagnostic laparoscopy was performed confirming the recurrence with transverse colon herniation through a left postero-lateral diaphragmatic defect size 5 × 5 cm and complete absence of the previously noted posterior rim. There were significant adhesions to the anterior abdominal wall, including the spleen, which were divided and mobilised haemostatically to allow complete assessment of the defect. A patch repair was performed using synthetic mesh anchored with interrupted non-absorbable sutures. Total operating time was under 120 minutes. The patient was discharged on the 3rd post-operative day with minimal analgesic requirements and no evidence of recurrence on follow-up radiographs. Conclusion: Laparoscopic repair is a safe and effective option for cases of CDH recurrence and is technically feasible despite the operative challenges that the surgeon will inevitably face as demonstrated in this case.

Background Peptic ulcer perforation (PPU) represents the main indication for emergent surgical intervention for peptic ulcer disease. The study aimed to assess the efficacy and safety of laparoscopic repair (PPU) in comparison with open repair in low-risk patients. Methods A retrospective study was conducted in a tertiary medical institution that included 98 patients diagnosed with PPU in line with the inclusion criteria. An analysis was performed to compare patients who underwent laparoscopic surgery (LS) (n=31) and patients submitted to open surgery (OS) of PPU (n=67). Characterization of LS and OS was achieved in terms of patients' demographics, Bœy's score, PULP score, and intraoperative and postoperative data. Results The patient's mean age in the LS and OS groups were 48.8 and 51.1 years, respectively. Most patients in both groups were men (87.1% and 86.5%, respectively). The mean time for resumption of oral intake after surgery was 2.93 ±1.06 (1–7) days in the laparoscopy group compared with 3.79±0.8 (2–7) days in the laparotomy group (P<0.0001). The average length of hospital stay was 5.77± 1.8 (4–13) days in the LS group and 7.22±1.6 (5–12) days in the OS group (P=0.0001). Early complications (<30 days) were found in 12 patients (12.2%); 3 (9.6%) in the LS group and 9 (13.4%) in the OS group (P=0.5). Conclusion Repair of PPU by laparoscopy is a better alternative to the open approach regarding reduction of postoperative hospital stay and fast return to daily activity with less postoperative ileus and wound complications. [ABSTRACT FROM AUTHOR]

Background: Acute diaphragmatic hernia is a life-threatening condition caused by prolapse of an abdominal organ into the thoracic cavity through a defect in the diaphragm. We present herein a case of acquired diaphragmatic hernia following a peritoneal biopsy for gastric cancer dissemination in the diaphragm. Case presentation: A 72-year-old, female patient presented with a complaint of acute abdomen 10 months after receiving a diagnosis of stage IV gastric cancer with peritoneal dissemination based on peritoneal biopsy findings during staging laparoscopy. Computed tomography demonstrated herniation of the small intestine into the thoracic cavity. Emergency surgery was performed, and a full-thickness diaphragmatic defect was found intraoperatively at the same location as the previous, peritoneal biopsy. The incarcerated small intestine was atraumatically repositioned into the abdominal cavity, and the defect was closed laparoscopically using an absorbable barbed suture. Conclusions: Although complications of staging laparoscopy are extremely rare, excising disseminated nodules from the diaphragm carries the risk of diaphragmatic hernia. For this reason, avoiding excision is desirable unless a diaphragmatic biopsy is needed. [ABSTRACT FROM AUTHOR]

Background: Recent international hernia guidelines state that work and leisure activities after inguinal hernia repair can be resumed after a convalescence of three to five days for most patients. There is no specific recommendation for convalescence duration before resuming sport and heavy lifting. This nationwide survey aimed to assess leading hernia surgeons' recommendations for convalescence after groin hernia repair and to explore their general opinions regarding convalescence. Methods: A validated questionnaire was sent to 32 leading groin hernia surgeons covering all Danish private and public hospitals. The primary outcome was convalescence recommendations following Lichtenstein and laparoscopic groin hernia repair for activities of daily living, light work, sport, and heavy lifting. Results: A total of 29 surgeons (91%) responded to the questionnaire. The surgeons generally agreed on resuming daily activities and light work as soon as possible according to the level of pain. For resumption of sport, the surgeons recommended a median convalescence of 14 days (IQR 10–23, range 7–30) after Lichtenstein repair and 14 days (IQR 10–21, range 7–30) after laparoscopic repair. Most of the surgeons instructed patients with a defined number of days before resuming heavy lifting, which after Lichtenstein repair was median 14 days (IQR 8–28, range 2–30) and after laparoscopic repair was median 21 days (IQR 14–30, range 7–30). None of the surgeons routinely prescribed sick leave. Seventeen surgeons (61%) thought that recommending a too short convalescence could cause complications, primarily recurrence, hematoma, and pain. Conclusion: This study revealed that surgeons agreed on the resumption of daily activities and light work as soon as possible according to the level of pain. However, a broad spectrum of convalescence recommendations was revealed for sport and heavy lifting. [ABSTRACT FROM AUTHOR]

Diastasis of the rectus abdominis muscles is defined according to Beer’s classification: the distance between the straight abdominal muscles greater than 2.2 cm, measured 3 cm above the belly button with relaxed abdomen. The conditions in which it occurs most frequently are 12 months post-partum or in obese subjects who have suffered evident weight loss. We retrospectively evaluated PubMed databases, Embase, and the Cochrane Library by applying various combinations of the subject-related terms. The search terms identified with the medical subject heading (MeSH) were “diastasis of the rectus abdominis (DMRA), laparoscopic repair, subcutaneous laparoscopic recti abdominis repair”. The aim of the study was to describe laparoscopic techniques for the correction of combined ventral hernia with the plication of the diastasis of the rectus abdominis, muscle and to present the results.

Laparoscopic surgery is still gaining popularity in conditions associated with peritonitis, such as a perforated peptic ulcer. Aim of the work This study aimed to compare laparoscopic and laparotomy repair of perforated peptic ulcers regarding intraoperative parameters, postoperative pain, time of the start of oral feeding, postoperative complication, hospital stay, resuming normal activity, and outcomes. Patients and methods This is a prospective study of 50 patients (males and females), of any age with perforated peptic ulcer. Those patients will be divided by the random serial number method into two groups: the laparoscopic group and the open (laparotomy) group. In a period from 15th April 2022 to 15th February 2023 data related to patients were recorded and subjected to analysis. Results All patients were divided into two groups: Laparoscopic group with 25 patients (23 of them underwent successful laparoscopic repair and two patients were converted to open) and the open (laparotomy) group with 25 patients underwent laparotomy repair (of which 23 patients were living, and two patients died on the third and tenth postoperative days). There were no significant differences in baseline characteristics between both groups in terms of age, gender, special habits, preoperative risk factors, comorbidities, laboratory, and radiological findings; also both groups showed insignificant differences regarding the American Society of Anesthesiologists (ASA) scores (P=0.83), total Boey's score (P=0.77), shock on admission (P= 1.00), and the duration of symptoms > 24 hours (P= 0.77). Operative time was significantly increased in the laparoscopic versus open group (P=0.0001). While, first-day pain score (VAS), opioid requirements, time of starting oral feeding, length of hospital stay, and return to normal activity were highly significantly decreased in laparoscopic repair compared with open repair (P= <0.0001 for each). Total postoperative complications showed insignificant difference between the studied groups (P=0.16), but they were more prevalent between the open group (14 patients, 56%) versus the laparoscopic group (9 patients, 36%). Good cosmetic results of wounds were more prevalent in the laparoscopic group [20 patients (80.00%)] than the open group [13 patients (56.52%)], but insignificant, P=0.17. Conclusion Laparoscopic repair had an upper hand over open repair regarding less intraoperative blood loss, less postoperative pain, requiring less postoperative analgesia, early starting of oral feeding, less postoperative complications, shorter hospital stay, early return to normal activity, and good cosmetic results of wounds. [ABSTRACT FROM AUTHOR]

Background: The current gold standard of treatment for giant hiatal hernias (GHHs) is laparoscopic surgery. Laparoscopic surgery was performed as a less invasive procedure for paraesophageal hernias more than 25 years ago. Its viability and safety have almost all been shown. Materials and Methods: A review of recent and current studies' literature was done. Prospective randomized trials, systematic reviews, clinical reviews, and original articles were all investigated. The data were gathered in the form of a narrative evaluation. We examine the state of laparoscopic GHH repair today and outline the GHH management strategy. Results: In this review, we clear up misunderstandings of GHH and address bad habits that may have contributed to poor results, and we have consequently performed a methodical evaluation of GHH. First, we address subcategorizing GHH and provide criteria to define them. The preoperative workup strategies are then discussed, with a focus on any pertinent and frequent atypical symptoms, indications for surgery, timing of surgery, and the importance of surgery. The approach to the techniques and the logic behind surgery are then presented along with some important dissection techniques. Finally, we debate the role of mesh reinforcement and evaluate the data in terms of recurrence, reoperation rate, complications, and delayed stomach emptying. Finally, we suggest a justification for common postoperative investigations. Conclusions: Surgery is the only effective treatment for GHH at the moment. If the right operational therapy principles are applied, this is generally successful. There is a growing interest in laparoscopic paraesophageal hiatal hernia repair as a result of the introduction of laparoscopic antireflux surgery. Today's less invasive procedures provide a better therapeutic choice with a lower risk. [ABSTRACT FROM AUTHOR]

Introduction: Spiegelian hernia is an extremely rare ventral hernia, with an incidence of less than 2 %. The laparoendoscopic approach has become the surgical method of choice, with successful use of transabdominal (IntraPeritoneal Onlay Mesh [IPOM]) and preperitoneal (TransAbdomino-PrePeritoneal [TAPP] and Totally ExtraPeritoneal [TEP]) techniques. We present our experience in the implementation of these techniques, over the last 10 years, in an outpatient and short stay surgery hospital. Methods: We present a series of 31 patients operated by laparoendoscopic approach between February 2011 and June 2021. The three techniques were used according to the location of the defect and the progressively acquired experience in laparoendoscopic abdominal wall surgery. Demographic, clinical, diagnostic, surgical and postoperative characteristics are evaluated in the short and medium term. Results: 33 hernias were operated on in 31 patients (22 females and 9 males) with a mean age of 66.43 years, all ASA I-II. 14 IPOM were performed at the beginning of the series, 11 TAPP and 8 TEP with subsequent implementation. The mean operative time was 58.14 minutes. The mean hospital stay was 24.76 hours. The most frequent complication was seroma. Follow-up was between 1 month and 2 years. All histories were reviewed and no recurrence was found in any patient. Conclusion: Laparoendoscopic surgery offers excellent results and should become the standard of care. It has not been demonstrated which technique is superior and the choice will depend on the type of patient and the surgeon's expertise, experience and results. [ABSTRACT FROM AUTHOR]

Background: Ventral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed. Objectives: The aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias. Methods: A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Results: Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32–0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19–0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02–0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19–0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Conclusion: The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma. [ABSTRACT FROM AUTHOR]

Objective: To compare the reoperation rate for recurrence between different mesh types in laparoscopic ventral hernia repair. Summary of Background Data: Ventral hernia repair has improved over the last decades. Nevertheless, recurrence rates are still high, and one type of mesh was recently found to increase it even more. Methods: A nationwide cohort study based on prospectively collected data from the Danish Ventral Hernia Database. We included adult patients that had undergone a laparoscopic ventral hernia repair for either an incisional or a primary hernia. The primary and incisional hernias were analyzed in separate cohorts. The mesh-group with the lowest reoperation for recurrence curve was used as the reference. The outcome was reoperation for recurrence. Results: Study population comprised 2874 patients with primary hernias and 2726 with incisional hernias. For primary hernias, Physiomesh [HR = 3.45 (2.16–5.51)] and Proceed Surgical Mesh [HR = 2.53 (1.35–4.75)] had a significantly higher risk of reoperation for recurrence than DynaMesh-IPOM. For incisional hernias, Physiomesh [HR = 3.90 (1.80–8.46), Ventralex Hernia Patch (HR = 2.99 (1.13–7.93), Parietex Composite (incl. Optimized) (HR = 2.55 (1.17–5.55), and Proceed Surgical Mesh (HR = 2.63 (1.11–6.20)] all had a significantly higher risk of reoperation for recurrence than Ventralight ST Mesh. Conclusion: For primary hernias, Physiomesh and Proceed Surgical Mesh had a significantly higher risk of reoperation for recurrence compared with DynaMesh-IPOM. For incisional hernias, the risk was significantly higher for Physiomesh, Parietex Composite, Ventralex Hernia Patch, and Proceed Surgical Mesh compared with Ventralight ST Mesh. This indicates that type of mesh may be associated with outcomes, and mesh choice could therefore depend on hernia type. [ABSTRACT FROM AUTHOR]

Background: Retrocaval ureter (RCU) is a rare congenital anomaly. It occurs due to anomalous development of inferior vena cava (IVC) and not ureter. Here, we describe our experience in surgical techniques and operative results of laparoscopic reconstruction for patients with RCU. Aims and Objectives: The aims of this study were to obtain information regarding clinical presentation, demographic profiles, investigations, indications for intervention, postoperative complications of laparoscopic repair of retrocaval repair, and also to develop laparoscopic surgical skill without causing any untoward effects to the patients. Materials and Methods: Twelve patients with RCU were enrolled in this study. The mean age was 32.4-years-old (23–37 years). All patients were preoperatively evaluated with different relevant imaging modalities. Laparoscopic surgery with transperitoneal approach with insertion of double-j stent was performed to all patients by same surgeon without excision of compressed ureter. Post-operative follow-up was done with ultrasonography every 3 months and repeat DTPA renogram every 6 months for 2.4 years. Results: All operations were completed laparoscopically without conversion to open surgery. There was no obstruction or symptom after the mean follow-up of 2.4 years. Conclusion: Transperitoneal laparoscopic repair is a feasible, safe, and effective modality of The treatment for RCU. Careful dissection along the planes with good respect to tissue and proper hemostasis during each step is the key to success for laparoscopic repair of RCU.

Abstract Background Blunt traumatic diaphragmatic hernia (TDH) is a complication of blunt diaphragmatic injury. If missed, it could lead to critical presentations, such as incarceration or strangulation of the herniated intra-abdominal organs, and thus, early surgical repair is required. Methods of the operative approach against delayed TDH remain unclear. Even with the spread of the minimally invasive approach, laparotomy has been predominantly selected for cases with hemodynamic or gastrointestinal complaints. Literature on the use of laparoscopy for repair of such cases is limited, and no study has been conducted for those with intrathoracic gastric perforation. Case presentation A 55-year-old male patient with a history of multiple traumas presented with shock, followed by left hypochondrium pain and vomiting. The patient was admitted to the emergency department of our institution and diagnosed with delayed TDH complicated by intrathoracic gastric perforation, and tension empyema. Emergency surgery using laparoscopic approach was performed, despite unstable hemodynamics, considering orientation, exposure, and operativity compared with laparotomy. Repair of the diaphragm plus total gastrectomy was successfully performed by minimally invasive management. The patient made an uneventful recovery without recurrence after 8 months. Conclusion Unstable hemodynamic conditions and intrathoracic gastric perforation could not be contraindications to laparoscopic repair in treating delayed TDH.

Introduction: Minimally invasive or open Graham Patch repair remains the gold standard approach for management of perforated peptic ulcers (PPU). Herein, we report outcomes of laparoscopic technique and compare it with open approach at a community hospital. Methods: Retrospective observational study conducted comparing laparoscopic modified Cellan-Jones repair (mCJR) versus the standard open repair of PPU. Patients aged 18–90 years during 2016–2021 were offered either a minimally invasive or open approach depending on surgeon laparoscopic capability, and were compared in terms of demographics, co-morbidities, intra-operative details, and short-term outcomes. Results: A total of 49 patients were included (46.9% males, mean age 52.9 years, mean BMI 25.0, ASA ≥ III 75.5%, 75.5% smokers, 26.5% current NSAIDs use, and 71.4% alcohol drinkers). Duodenum was the most common perforation site (57.1%), and majority of ulcers were 1–2 cm (72.9%). Laparoscopic approach was performed in 16 consecutive patients (32.7%) by a single surgeon, with no conversions. Preoperative characteristics were similar for both groups. Compared to open approach, laparoscopic group were taken to operation immediately (< 4 h) (87.5% vs. 15.2%, p < 0.001), had lower estimated blood loss (11.8 ml vs. 73.8 ml, p = 0.063), and longer operative time (117.1 min vs. 85.6 min, p = 0.010). Postoperatively, nasogastric tube was removed earlier in laparoscopic group (POD1-2, 87.5% vs. 24.2%, p = 0.001), with earlier resumption of diet (POD1-2, 62.6% vs. 9.1%, p = 0.002), less narcotic usage (< 3 days, 58.3% vs. 6.1%, p < 0.001), earlier return of bowel function (POD1-2, 43.8% vs. 9.1%, p = 0.003) and shorter length of stay (LOS) (3.7 days vs. 16.1 days, p < 0.001). Both in-house mortality and morbidity rates were lower in the laparoscopic group, but not statistically significant [(0% vs. 6.1%, p = 0.347) and (12.5% vs. 39.4%, p = 0.500), respectively]. Conclusion: Laparoscopic mCJR is a feasible method for repair of PPU, and it is associated with shorter LOS, and less narcotics usage in comparison to the open repair approach. [ABSTRACT FROM AUTHOR]

Current repair of abdominal wall hernias is accomplished with several laparoscopic and robotic techniques. The advantages of minimal invasive surgery are well known and, in comparison to open techniques, include lesser postoperative pain, lower incidence of surgical site and mesh infection, faster return to normal activities and lesser length of stay. In the past decades, evolution of operative technology is large with the development of laparoscopic instruments that have the wide range of articulation, movement, and rotation of robotic instruments. In this study we present the application of a new fully articulating needle holder instrument HandXTM for the repair of a postoperative umbilical hernia in a 64-year-old woman after a previous laparoscopic cholecystectomy. Repair included excision of hernia sac, suture-closure of hernia gap and intraperitoneal placement of a double-layer mesh (IPOM plus). Operative duration was less than 60 minutes, and the patient had an uneventful postoperative course and length of stay less than a day. [ABSTRACT FROM AUTHOR]

Inguinal hernias are a common problem in premature infants, with incidence increasing as the gestational age decreases. Direct inguinal hernias are rare in infants with minimal documentation in the medical literature. We present the case of a premature infant who was found to have a direct inguinal hernia containing bladder during laparoscopic inguinal hernia repairs. The patient was a premature 25-week gestational age infant admitted to the neonatal intensive care unit. At 3-months old, pediatric surgery was consulted for bilateral inguinal hernias. Intraoperatively, laparoscopic visualization of the hernias demonstrated a typical left indirect inguinal hernia; however, on the right side, we found a direct inguinal hernia, medial to the right medial umbilical ligament that contained a large portion of the bladder. The left indirect hernia was successfully repaired laparoscopically, while the right was repaired with conversion to an open Bassini repair. The postoperative course of the infant was unremarkable.

A 63-year-old woman was admitted with abdominal pain two months after laparoscopic abdominoperineal resection for rectal cancer. Computed tomography revealed dilated small intestine had passed through a defect between the lifted sigmoid colon and abdominal wall. She was diagnosed with small bowel obstruction without strangulation due to internal hernia and managed nonoperatively based on her wish. Recurrence of intestinal obstruction occurred for which curative surgery was performed laparoscopically. The herniated intestine was restored to the normal position, and the hernia orifice was closed using barbed suture, on laparoscopic management. Internal hernia is a rare complication after colostomy that requires surgical management. Although laparoscopic approach on re-operation is difficult, laparoscopic surgery may be suitable for patients with IHAC in terms of required less use of adhesiolysis. [ABSTRACT FROM AUTHOR]

Objective: The most common cause of gastroduodenal perforation is a perforated peptic ulcer (PPU). Laparoscopic repair has proved to be beneficial over open repair in terms of less post-op pain and a shorter length of stay. However, complications from site leak and intra-abdominal abscess are more common. The author reported the outcomes of three laparoscopic repair procedures: simple closure alone (SC), simple closure with omental patch (SCO), and simple closure alone with leak test (SCL) in 58 patients who presented with perforated gastroduodenal lesions. Methods: Between July 2011 and October 2020, retrospective data of 58 patients with gastroduodenal perforation and underwent SC, SCO, and SCL were analyzed. Results: There were 57 benign peptic ulcers and 1 gastric cancer perforation. Laparoscopic surgery was accomplished in 52 cases (89.7%) and was converted to open surgery in 6 cases (10.3%). SCO was performed in 13 cases (22.4%), SC in 15 cases (25.9%) and SCL in 24 cases (41.4%). In the SCL group, wound leakage was detected in 2 cases (8.3%) and both were corrected intra-operatively. There was no site leak or intra-abdominal abscess in this study, and no re-operation was required. Two deaths (3.4%) were found in this study. Conclusion: SCO for large ulcers was a safe procedure but took longer operative time. SC for small ulcer was secure with shorter operative time. SCL for high-risk ulcers could detect site leak intra-operatively and could prevent post-operative complications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe a simple extravesical laparoscopic approach for supratrigonal vesicovaginal fistula (VVF) repair without cystotomy and closer of the vaginal vault. Materials and Methods: This retrospective observational study reviewed data of 36 patients from January 2015 to January 2020. In our technique, the fistula tract was identified without cystotomy with the help of preplaced ureteric catheter in VVF tract. After meticulous extravesical dissection of the fistula tract, the bladder wall was closed in a single layer using polyglactin 2.0 sutures. The omental flap was approximated over the vaginal vault without primary closer of the vault. Results: In most of the patients the fistula opening were located 2 cm away from ureteric orifice while in 4 patients it located within 2 cm of orifice. The mean operative time was 86 min (65-125) and estimated blood loss was 94 ml (40-130). The mean size of fistula was 7.1 mm (5-15 mm). Omental flap was approximate over vaginal opening in most of the patients. The average hospital stay of patients was 5 days. In all patients, Foley catheter was removed on day 14 after cystogram. The mean follow-up of patients was 4.2 months (3-7). All patients remained continent and symptom free during the follow-up periods. Conclusion: Our technique without suturing of the vaginal vault in laparoscopic VVF repair is safe in a simple supratrigonal fistula with good results and avoiding added suturing. [ABSTRACT FROM AUTHOR]

Objective: Obesity is a global health problem, and obese patients are subject to developing abdominal wall hernias. There are few prospective studies comparing the laparoscopic method of umbilical hernia mesh repair between abdominal obesity patients and normal abdominal waist patients. The aim of this study was to evaluate the short-term outcomes (operative time, early complications and hospital stay) in the patients having laparoscopic hernia repair with abdominal obesity. Methods: This prospective cohort study was conducted at King Fahad Hospital Hofuf, Kingdom of Saudi Arabia from June 2014 to June 2021. Fifty four (54) adult male patients with umbilical hernia were included in this study. The patients were divided into two groups: Group-A: Patients with abdominal obesity (n=26), and Group-B: Patients without abdominal obesity (n=28). All the patients underwent laparoscopic repair of umbilical hernia. The patients with abdominal obesity were defined as those having an abdominal girth more than 102 centimeters. Results: No significant differences were observed as related to age, co-morbidity and risk factors between the two groups. The statistically significant difference between the two groups observed was related to the mean operative time and the mean hospital stay. Conclusion: Laparoscopic umbilical hernia repair can be safely performed in abdominal obesity in male patients without an additional risk of complications. [ABSTRACT FROM AUTHOR]

Purpose: When laparoscopically repairing a symptomatic inguinal hernia, surgeons will discover a contralateral asymptomatic hernia in 22% of patients. It is estimated 30% of asymptomatic hernias become symptomatic and require repair. Thus, should they be repaired in a 2-for-1 operation? The main purpose is to examine the evidence and make a recommendation for the need to repair the contralateral asymptomatic inguinal hernia prophylactically in the adult population during unilateral inguinal hernia presentation. Method: A systematic literature search was conducted up to 15 February 2021 using PubMed and the Cochrane Library. Management pathway taken, mean operating time, duration of follow-up, pain, duration of hospital stay and perioperative complications were extracted. Risk of bias was assessed using the ROBINS-I tool. Results: Six non-randomised studies (1774 patients) were included; 978 patients had both hernias repaired, 796 patients had only the symptomatic hernia repaired. There was no significant difference in length of hospital stay, return to activities of daily living nor complications. Mean operating time was slightly lower for patients who had unilateral hernia repair (mean difference = − 14.57 min, 95%CI − 25.59, − 3.45). Reported pain scores were lower for patients who only had one hernia repaired (− 0.33 units, 95%CI − 0.48, − 0.18). The overall risk of bias for the six studies were low-to-moderate risk. Conclusion: Asymptomatic inguinal hernias can be repaired when found. While there is minimal increase in operation time and pain, no significant difference to total hospital stay. Importantly, this is likely to prevent the need for another operation in almost a third of patients. [ABSTRACT FROM AUTHOR]